(PS2-A22) Perceived Likelihood of Future Suicide Attempts: The Limited Role of Plans for Suicide

Objective: The present study determined if having a plan for suicide, regardless of method, is associated with an individual’s self-reported likelihood of attempting suicide in the future. Additionally, we sought to determine if having a plan with a specific method (i.e., firearm, medication) is associated with self-reported likelihood of attempting suicide in the future, thereby examining whether planning with specific methods is more likely to be associated with an individual’s perception that they will likely attempt suicide in the future. Lastly, in an exploratory manner, we examined if those who attempted suicide between the baseline and the follow-up appointments utilized the method that they reported considering at baseline, thereby demonstrating consistency between plans involving specific methods and actual suicidal behaviors. Findings from this study have important implications for suicide prevention efforts. Specifically, demonstrating that having a plan for suicide with a specific method is more closely associated with an individual believing they will attempt suicide in the future would have meaningful implications for how we assess and respond to suicide risk.

Method:  Participants (N = 97) were United States Army personnel recruited from emergency departments and behavioral health clinics. Participation in the study included baseline, 1-month, 3-month, and 6-month appointments. Inclusion criteria required participants to have past week suicidal ideation and/or a lifetime history of a suicide attempt.

Results: Perceived likelihood of attempting suicide in the future was not associated with the presence of a plan for suicide. Between the baseline appointment and the three follow-ups, 37 participants attempted suicide (38.1%). Some participants (n = 4) attempted multiple times and, in total, there were 41 suicide attempts across the follow-up period. Multiple attempts (n = 6; 14.6%) utilized a different method than was noted in their plan at baseline. Medication was the most commonly used method among those who did not use the method reported at baseline (66.7%, n = 4). Only 2.4% (n =1) used the method that was considered during baseline. For a majority of attempts, (82.9%; n = 34) no plan was mentioned at baseline.


 

Discussion: This study expands our understanding of the role of suicide plans in overall suicide risk. Despite being considered an indication of elevated risk by many clinicians, our findings suggest that presence or absence of suicide plans is not associated with more action-oriented thoughts about future suicidal behavior. This seems to align with prior research and theory indicating that suicidal crises are brief and that plans for suicide may change more rapidly than current assessment methods can capture. Future research should continue to explore how suicide plans change over time and across suicidal crises (e.g., Measure of Episodic Planning of Suicide; Anestis, Pennings, & Williams, 2014) to better understand this risk factor. In the meantime, clinicians and researchers may benefit from a broader approach to risk assessment and safety planning that does not rely too heavily on an individual’s self-reported plans for suicide.